3- Clinical Assessment, Diagnosis, And Research Methods
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Emotions Not to be confused with Mood- persistent period of emotionality Affect- momentary emotional tone that accompanies what we say or do Facial expression or body language
Emotions can have physical effects which is studied in the field of Health Psychology
Clinical Assessment, Diagnosis, and Research Methods
Chapter 3a
Key concepts in Assessment The value of assessments is measured by Reliability- Consistency Test- retest- across time Inter-rater- across raters
Validity- Measures what it’s designed to Construct- criteria differs for each category Content- agreement between experts
Cultural, Social, and Interpersonal Factors Psychopathology can be associated with certain Cultures Haitian Voodoo or Malay “amok”
Genders Phobias, Addictions, and Eating Disorders
Life stages Different periods of development have different vulnerabilities
Assessing Psychological Disorders Processes that are central to the study of psychopathology: Clinical Assessment- systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with psychological symptoms Diagnosis- process of determining whether the individual meets the DSM-IV- TR criteria for a psychological disorder
Key concepts in Assessment Validity Criterion Predictive- can predict course and consequence Concurrent or Descriptive- describes pop. tested Convergent- agreement between test and theory
Standardization- process by which a set of standards/norms is established for a technique to ensure its consistency across different measurements
Key concepts in Assessment One can have high reliability without validity, but not validity without reliability
Methods for Acquiring Client Information Clinical Interview Mental Status Exam
Physical Exam Behavioral Observation and Assessment Self-report
Psychological Testing
Acquiring Client Information
Acquiring Client Information
Clinical Interview- Detailed history of the subject’s life and presenting problem
Can be unstructured (PANSS), semistructured (SCID), or structured Important points to cover include
Gathers information on current and past
Behaviors Relationships Events Attitudes and Emotions
Acquiring Client Information Mental Status Exam- is a systematic observation MSE is a process of preliminary determination about which areas should be more thoroughly assessed
precipitating events family composition and history sexual development religious beliefs and cultural concerns educational achievement social-interpersonal history.
Areas covered by the Mental Status Exam Appearance and Behavior
Overt Behavior Dress Posture and facial expression Motor activity
Mood and Affect Depressed mood Inappropriate Affect
Flat
Blunted
Areas covered by the Mental Status Exam
Areas covered by the Mental Status Exam
Intellectual Functioning
Thought Process
Vocabulary Abstractions Metaphors Memory
Sensorium
Speech rate and pattern Logical continuity Delusions (persecution, grandeur, and/or ideas of reference) Hallucinations (most commonly auditory)
Orientation x 3
Assessing Psychological Disorders
Assessing Psychological Disorders
Physical Exam- Determines the presence of medical/biological origins of symptoms
Behavioral Assessment- Measuring, observing, and systematically evaluating the thoughts, feelings, and behavior in the context of the actual situation
Hyperthyroidism- mimics some anxiety d/o Hypothyrodism- mimics depression Drug induced paranoia or dementia Medicine overdose or side-effect Brain tumors or other neuropathologies
Assessing Psychological Disorders Observation- Takes into account the antecedents and consequences of target behavior Informal Observation and Formal Observation (operational definition of behaviors in specific and measurable terms) Self-Monitoring Behavior Rating Scales
Reactivity- the mere act of observation sometimes changes behavior
Community observation or Role-plays Goal is to identify target behaviors
Usually used for children and non-verbal adults Backs up self-reports
Assessing Psychological Disorders Psychological Tests- Strict standards of reliability, validity, and standardization, NOT like surveys or “personality tests” found on web or magazines Projective Tests- Psychoanalytic measures that present ambiguous stimuli to clients with the assumption that responses will reveal unconscious conflicts Low reliability and validity, therefore controversial but sometimes useful
Rorschach Inkblot Test
Thematic Apperception Test
Assessing Psychological Disorders
Assessing Psychological Disorders
Personality Inventories- Self-report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them MMPI (Minnesota Multiphasic Personality Inventory) Empirical (based on collected and evaluated data) True or False as opposed to a Likert Scale
Assessing Psychological Disorders Neuropsychological tests are screening devices which have a high accuracy but are not immune to False positives- Finding disorder when there is none False negative- No finding of disorder when there is one
Intelligence Quotient- Score on an intelligence test estimating a person’s deviation from average test scores, usually valid, reliable, and normed WAIS-III and all tests contain Verbal Scales Performance Scales
Shipley Institute of Living Scale
But IQ tests also measure attention, perception, memory, reasoning, and comprehension
Assessing Psychological Disorders Neuropsychological Tests- Assesses brain and nervous system functioning by testing performance on behavioral tasks Bender Visual-Motor Gestalt Test Halstead- Reitan Neuropsychological Battery Rhythm Test Strength of Grip Test Tactile Performance Test
BRIEF-A
Assessing Psychological Disorders Neuroimaging- Sophisticated computeraided procedures that allow nonintrusive exam of nervous system structure and function CAT or CT Scans MRI and fMRI PET and SPECT
Assessing Psychological Disorders Biofeedback treatments Meters gauge physiological responses (HR, BP, etc.) to events which are fed back to the patient so patient can try to consciously regulate them
Assessing Psychological Disorders Psychophysiological AssessmentMeasurement of changes in the nervous system reflecting emotions or cognitions (evoked- potential) EEG- measure electrical activity in the brain (cortex) Alpha waves (relaxed and awake) Delta waves (deep sleep)
Clinical Assessment, Diagnosis, and Research Methods
Chapter 3b
Review
Review
Two central processes:
Two central processes :
Clinical Assessment- Getting information Clinical Interview Mental Status Exam
Physical Exam Behavioral Observation and Assessment Informal and Formal Observation & Rating Scales
Psychological Testing Projective, Personality, IQ, & Neuropsychological
Diagnosis- Seeing where it fits Classification Classical categorical approach – Clear categories Dimensional approach- Continuum Prototypical approach- Essential 1º characteristics and a range of variation on 2º characteristics
Review Value of both assessments and diagnosis are determined by Reliability- Consistency Validity- Measuring what it says it’s measuring Standardization (Norming)- Defining what is “normal” or statistical majority
Diagnosing Psychological Disorders Diagnosis- identifying a general class of problems that hang together Useful for obtaining information about
Psychological profiles Etiology Treatment Prognosis
Diagnosing Psychological Disorders
Diagnosing Psychological Disorders
DSM-IV-TR
DSM-IV-TR
Empirically based worldwide nosology for psychological disorders Social and cultural considerations
DSM-IV-TR Labeling forces a fuzzy diagnosis into a category Might have negative connotations (stigma) May be applied erroneously, the person becomes the disorder Usually means more comorbidities
Sometimes sacrificed validity for reliability
Multi-Axial System Axis I- Clinical disorders Axis II- Personality disorders and MR Axis III- Medical conditions Axis IV- Psychosocial and environmental factors Axis V- Global Assessment of Functioning; (GAF goes from 0 to 100)
DSM-IV-TR Being revised at the moment to become a more dimensional classification system Points on a continuum rather than categories
The criticism of that is that if you remove a classification, diagnosis will be even harder to make- similar to the DSM-I
Conducting Research in Psychopathology
Conducting Research in Psychopathology
It starts with a an observation...
Which leads to question...
Conducting Research in Psychopathology
Conducting Research in Psychopathology
The hypothesis is the educated guess to answer that question...
But how do you know if your answer is right and the information is useful? Testability- ability to be subjected to scientific scrutiny
OR
comes in the form of a research designplan of experimentation
Conducting Research in Psychopathology
Conducting Research in Psychopathology
The research design uses the aspects you want to measure in the people you are studying
The value of the research design is determined by two inverse forms of validity
Independent variable- the factor that is manipulated by the experimenter expected to influence the dependent variable
Dependent variable- the factor that is measured and expected to be influenced
Internal Validity
External Validity
Conducting Research in Psychopathology Internal validity - extent to which we are confident that the independent variable caused the dependent variable to change. External validity -how well the findings generalize to people who were not part of the research study.
The more a study applies to its participants, the less generalizable it is
Conducting Research in Psychopathology Internal validity is threatened by confounds Uncontrolled alternative explanations that contaminate the result of the study Its effects cannot be separated from those of the variables being studied
Three strategies to Ensure Internal Validity
Three strategies to Ensure Internal Validity
Control group - Similar to the experimental subjects in every way, but are not exposed to the independent variable (i.e. treatment received)
Randomization - Study participants are assured an equal chance of being assigned to any of the groups (and in turn any of the treatments)
+ allows for comparison of differential effects from treatment
Three strategies to Ensure Internal Validity Analog model - A way of studying a phenomenon by creating a comparable (analogous) environment within the laboratory + allows for replication under controlled conditions
+ eliminates systematic differences across groups
Significance of Results Statistical significance - small probability that the research findings were found by chance Clinical significance - degree of meaningful applications of the finding to real world problems Effect size determines whether a statistically significant difference is also clinically significant
Conducting Research in Psychopathology A problem with psychopathology research is that individual differences are often de-emphasized The patient uniformity myth- tendency to see all participants as one homogeneous group hides important difference in individual reactions to interventions
Types of Research Methods Research by Correlation Degree to which two variables are associated Positive Correlation
Types of Research Methods Studying individual cases Case- studies in which a single person or a small group is studied in detail Freud - Does not use scientific method - Does not allow conclusions about cause and effect because of many confounding variables - Cannot be easily generalized
Types of Research Methods Correlation coefficient indicates the strength of the relationship, ranges from +1.00 to -1.00 How closely each point lies in a line graph
Negative Correlation
Types of Research Methods However, correlation does not imply causation! Just because two things occur together does not mean one causes the other And if one does cause the other, directionality is not indicated
Types of Research Methods Epidemiological Research Research method that examines Prevalence- How many people have the disorder at one time Incidence- How many new cases during a specific period of time Distribution- What percentage of different groups have the disorder Consequence- Personal, social, and economic impact of the disorder
Types of Research Methods
Types of Research Methods
Research by Experiment
Group experimental designs
Involves the manipulation of an independent variable and the observation of its effects of the dependent variable(s) of interest Addresses issues of causality Can be Group or Single Case Experiments
Types of Research Methods Outcome experiments are prone to placebo effect (Latin: “I shall please”) Experimental group has a positive expectation because they are getting treatment
Process experiments examine why it works Outcome experiments examine whether it works
Types of Research Methods Participants can be placed in a placebo control group could be given a similar procedure Sugar pills instead of actual medicine
The alternative is comparative treatment method Two or more treatment methods are compared to see which is more effective
Types of Research Methods
Types of Research Methods
There might also an expected outcome from the researchers themselves
Single-case Experiments involves manipulating variables on only one person
As a countermeasure the experiment could have a double-blind control Both the participants and the researcher do not know which treatment is being applied
The individual serves as their own control, by providing a baseline of function at the start of experiment + Repeated measurement shows Degree of variability (day to day change) Trend (direction of overall change)
Types of Research Methods
Conducting Research in Psychopathology Withdrawal Design + Makes sure that treatment is responsible for change - Treatment or its effects can’t always be removed
Multiple Baseline design Measures baselines of two or more related behaviors or one behavior in two or more different contexts Intervention after each instance, if treatment and changes coincide, then it is strong evidence of effect
Research Across Time
Research Across Time
A cross-sectional study compares the same characteristic in different people at different ages
Retrospective Information asks people to look back into their own childhoods
+ A disorder can be can be studied in different cohorts (age group) to map the disorder’s progression - Developmental stages and experience will be confounding factors in the study leading to a cohort effect
- Not very accurate
Sequential Designs repeated study of different cohorts over time
Research Across Time
Genetics
Longitudinal Designs study the same people across time
Genetic studies are done through
+ No cohort effects + Can measure actual progression - Expensive and Long-term - Cross-generational effect limits generalizability
Family Studies study the person with the trait (proband) Twin Studies have same environment, same genes Adoption Studies have different environment, similar genes Genetic linkage analysis and association studies can locate the site of the defective gene
Last Words The clinical picture, causal factors, and treatment process and outcome are culturally influenced A strong research design is both Replicable and Ethical Has strict scientific standards Involves knowledgeable Consumers Informed consent
Emotions can have physical effects which is studied in the field of Health Psychology
Clinical Assessment, Diagnosis, and Research Methods
Chapter 3a
Key concepts in Assessment The value of assessments is measured by Reliability- Consistency Test- retest- across time Inter-rater- across raters
Validity- Measures what it’s designed to Construct- criteria differs for each category Content- agreement between experts
Cultural, Social, and Interpersonal Factors Psychopathology can be associated with certain Cultures Haitian Voodoo or Malay “amok”
Genders Phobias, Addictions, and Eating Disorders
Life stages Different periods of development have different vulnerabilities
Assessing Psychological Disorders Processes that are central to the study of psychopathology: Clinical Assessment- systematic evaluation and measurement of psychological, biological, and social factors in a person presenting with psychological symptoms Diagnosis- process of determining whether the individual meets the DSM-IV- TR criteria for a psychological disorder
Key concepts in Assessment Validity Criterion Predictive- can predict course and consequence Concurrent or Descriptive- describes pop. tested Convergent- agreement between test and theory
Standardization- process by which a set of standards/norms is established for a technique to ensure its consistency across different measurements
Key concepts in Assessment One can have high reliability without validity, but not validity without reliability
Methods for Acquiring Client Information Clinical Interview Mental Status Exam
Physical Exam Behavioral Observation and Assessment Self-report
Psychological Testing
Acquiring Client Information
Acquiring Client Information
Clinical Interview- Detailed history of the subject’s life and presenting problem
Can be unstructured (PANSS), semistructured (SCID), or structured Important points to cover include
Gathers information on current and past
Behaviors Relationships Events Attitudes and Emotions
Acquiring Client Information Mental Status Exam- is a systematic observation MSE is a process of preliminary determination about which areas should be more thoroughly assessed
precipitating events family composition and history sexual development religious beliefs and cultural concerns educational achievement social-interpersonal history.
Areas covered by the Mental Status Exam Appearance and Behavior
Overt Behavior Dress Posture and facial expression Motor activity
Mood and Affect Depressed mood Inappropriate Affect
Flat
Blunted
Areas covered by the Mental Status Exam
Areas covered by the Mental Status Exam
Intellectual Functioning
Thought Process
Vocabulary Abstractions Metaphors Memory
Sensorium
Speech rate and pattern Logical continuity Delusions (persecution, grandeur, and/or ideas of reference) Hallucinations (most commonly auditory)
Orientation x 3
Assessing Psychological Disorders
Assessing Psychological Disorders
Physical Exam- Determines the presence of medical/biological origins of symptoms
Behavioral Assessment- Measuring, observing, and systematically evaluating the thoughts, feelings, and behavior in the context of the actual situation
Hyperthyroidism- mimics some anxiety d/o Hypothyrodism- mimics depression Drug induced paranoia or dementia Medicine overdose or side-effect Brain tumors or other neuropathologies
Assessing Psychological Disorders Observation- Takes into account the antecedents and consequences of target behavior Informal Observation and Formal Observation (operational definition of behaviors in specific and measurable terms) Self-Monitoring Behavior Rating Scales
Reactivity- the mere act of observation sometimes changes behavior
Community observation or Role-plays Goal is to identify target behaviors
Usually used for children and non-verbal adults Backs up self-reports
Assessing Psychological Disorders Psychological Tests- Strict standards of reliability, validity, and standardization, NOT like surveys or “personality tests” found on web or magazines Projective Tests- Psychoanalytic measures that present ambiguous stimuli to clients with the assumption that responses will reveal unconscious conflicts Low reliability and validity, therefore controversial but sometimes useful
Rorschach Inkblot Test
Thematic Apperception Test
Assessing Psychological Disorders
Assessing Psychological Disorders
Personality Inventories- Self-report questionnaires that assess personal traits by asking respondents to identify descriptions that apply to them MMPI (Minnesota Multiphasic Personality Inventory) Empirical (based on collected and evaluated data) True or False as opposed to a Likert Scale
Assessing Psychological Disorders Neuropsychological tests are screening devices which have a high accuracy but are not immune to False positives- Finding disorder when there is none False negative- No finding of disorder when there is one
Intelligence Quotient- Score on an intelligence test estimating a person’s deviation from average test scores, usually valid, reliable, and normed WAIS-III and all tests contain Verbal Scales Performance Scales
Shipley Institute of Living Scale
But IQ tests also measure attention, perception, memory, reasoning, and comprehension
Assessing Psychological Disorders Neuropsychological Tests- Assesses brain and nervous system functioning by testing performance on behavioral tasks Bender Visual-Motor Gestalt Test Halstead- Reitan Neuropsychological Battery Rhythm Test Strength of Grip Test Tactile Performance Test
BRIEF-A
Assessing Psychological Disorders Neuroimaging- Sophisticated computeraided procedures that allow nonintrusive exam of nervous system structure and function CAT or CT Scans MRI and fMRI PET and SPECT
Assessing Psychological Disorders Biofeedback treatments Meters gauge physiological responses (HR, BP, etc.) to events which are fed back to the patient so patient can try to consciously regulate them
Assessing Psychological Disorders Psychophysiological AssessmentMeasurement of changes in the nervous system reflecting emotions or cognitions (evoked- potential) EEG- measure electrical activity in the brain (cortex) Alpha waves (relaxed and awake) Delta waves (deep sleep)
Clinical Assessment, Diagnosis, and Research Methods
Chapter 3b
Review
Review
Two central processes:
Two central processes :
Clinical Assessment- Getting information Clinical Interview Mental Status Exam
Physical Exam Behavioral Observation and Assessment Informal and Formal Observation & Rating Scales
Psychological Testing Projective, Personality, IQ, & Neuropsychological
Diagnosis- Seeing where it fits Classification Classical categorical approach – Clear categories Dimensional approach- Continuum Prototypical approach- Essential 1º characteristics and a range of variation on 2º characteristics
Review Value of both assessments and diagnosis are determined by Reliability- Consistency Validity- Measuring what it says it’s measuring Standardization (Norming)- Defining what is “normal” or statistical majority
Diagnosing Psychological Disorders Diagnosis- identifying a general class of problems that hang together Useful for obtaining information about
Psychological profiles Etiology Treatment Prognosis
Diagnosing Psychological Disorders
Diagnosing Psychological Disorders
DSM-IV-TR
DSM-IV-TR
Empirically based worldwide nosology for psychological disorders Social and cultural considerations
DSM-IV-TR Labeling forces a fuzzy diagnosis into a category Might have negative connotations (stigma) May be applied erroneously, the person becomes the disorder Usually means more comorbidities
Sometimes sacrificed validity for reliability
Multi-Axial System Axis I- Clinical disorders Axis II- Personality disorders and MR Axis III- Medical conditions Axis IV- Psychosocial and environmental factors Axis V- Global Assessment of Functioning; (GAF goes from 0 to 100)
DSM-IV-TR Being revised at the moment to become a more dimensional classification system Points on a continuum rather than categories
The criticism of that is that if you remove a classification, diagnosis will be even harder to make- similar to the DSM-I
Conducting Research in Psychopathology
Conducting Research in Psychopathology
It starts with a an observation...
Which leads to question...
Conducting Research in Psychopathology
Conducting Research in Psychopathology
The hypothesis is the educated guess to answer that question...
But how do you know if your answer is right and the information is useful? Testability- ability to be subjected to scientific scrutiny
OR
comes in the form of a research designplan of experimentation
Conducting Research in Psychopathology
Conducting Research in Psychopathology
The research design uses the aspects you want to measure in the people you are studying
The value of the research design is determined by two inverse forms of validity
Independent variable- the factor that is manipulated by the experimenter expected to influence the dependent variable
Dependent variable- the factor that is measured and expected to be influenced
Internal Validity
External Validity
Conducting Research in Psychopathology Internal validity - extent to which we are confident that the independent variable caused the dependent variable to change. External validity -how well the findings generalize to people who were not part of the research study.
The more a study applies to its participants, the less generalizable it is
Conducting Research in Psychopathology Internal validity is threatened by confounds Uncontrolled alternative explanations that contaminate the result of the study Its effects cannot be separated from those of the variables being studied
Three strategies to Ensure Internal Validity
Three strategies to Ensure Internal Validity
Control group - Similar to the experimental subjects in every way, but are not exposed to the independent variable (i.e. treatment received)
Randomization - Study participants are assured an equal chance of being assigned to any of the groups (and in turn any of the treatments)
+ allows for comparison of differential effects from treatment
Three strategies to Ensure Internal Validity Analog model - A way of studying a phenomenon by creating a comparable (analogous) environment within the laboratory + allows for replication under controlled conditions
+ eliminates systematic differences across groups
Significance of Results Statistical significance - small probability that the research findings were found by chance Clinical significance - degree of meaningful applications of the finding to real world problems Effect size determines whether a statistically significant difference is also clinically significant
Conducting Research in Psychopathology A problem with psychopathology research is that individual differences are often de-emphasized The patient uniformity myth- tendency to see all participants as one homogeneous group hides important difference in individual reactions to interventions
Types of Research Methods Research by Correlation Degree to which two variables are associated Positive Correlation
Types of Research Methods Studying individual cases Case- studies in which a single person or a small group is studied in detail Freud - Does not use scientific method - Does not allow conclusions about cause and effect because of many confounding variables - Cannot be easily generalized
Types of Research Methods Correlation coefficient indicates the strength of the relationship, ranges from +1.00 to -1.00 How closely each point lies in a line graph
Negative Correlation
Types of Research Methods However, correlation does not imply causation! Just because two things occur together does not mean one causes the other And if one does cause the other, directionality is not indicated
Types of Research Methods Epidemiological Research Research method that examines Prevalence- How many people have the disorder at one time Incidence- How many new cases during a specific period of time Distribution- What percentage of different groups have the disorder Consequence- Personal, social, and economic impact of the disorder
Types of Research Methods
Types of Research Methods
Research by Experiment
Group experimental designs
Involves the manipulation of an independent variable and the observation of its effects of the dependent variable(s) of interest Addresses issues of causality Can be Group or Single Case Experiments
Types of Research Methods Outcome experiments are prone to placebo effect (Latin: “I shall please”) Experimental group has a positive expectation because they are getting treatment
Process experiments examine why it works Outcome experiments examine whether it works
Types of Research Methods Participants can be placed in a placebo control group could be given a similar procedure Sugar pills instead of actual medicine
The alternative is comparative treatment method Two or more treatment methods are compared to see which is more effective
Types of Research Methods
Types of Research Methods
There might also an expected outcome from the researchers themselves
Single-case Experiments involves manipulating variables on only one person
As a countermeasure the experiment could have a double-blind control Both the participants and the researcher do not know which treatment is being applied
The individual serves as their own control, by providing a baseline of function at the start of experiment + Repeated measurement shows Degree of variability (day to day change) Trend (direction of overall change)
Types of Research Methods
Conducting Research in Psychopathology Withdrawal Design + Makes sure that treatment is responsible for change - Treatment or its effects can’t always be removed
Multiple Baseline design Measures baselines of two or more related behaviors or one behavior in two or more different contexts Intervention after each instance, if treatment and changes coincide, then it is strong evidence of effect
Research Across Time
Research Across Time
A cross-sectional study compares the same characteristic in different people at different ages
Retrospective Information asks people to look back into their own childhoods
+ A disorder can be can be studied in different cohorts (age group) to map the disorder’s progression - Developmental stages and experience will be confounding factors in the study leading to a cohort effect
- Not very accurate
Sequential Designs repeated study of different cohorts over time
Research Across Time
Genetics
Longitudinal Designs study the same people across time
Genetic studies are done through
+ No cohort effects + Can measure actual progression - Expensive and Long-term - Cross-generational effect limits generalizability
Family Studies study the person with the trait (proband) Twin Studies have same environment, same genes Adoption Studies have different environment, similar genes Genetic linkage analysis and association studies can locate the site of the defective gene
Last Words The clinical picture, causal factors, and treatment process and outcome are culturally influenced A strong research design is both Replicable and Ethical Has strict scientific standards Involves knowledgeable Consumers Informed consent
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